Will Blue Cross Blue Shield Cover my breast reduction surgery?

Question

I am 5'4'' and I am 170 pounds (overweight for my height). I always had big boobs but they are getting bigger and I am getting back pain. I am also a little hunchback and my shoulders and back posture can not be straight. I am a 38 DD or maybe even a DDD. The surgeon that will do the surgery if approved just submitted a letter from me primary doctor of her telling them of my pain and breast problems and the surgeon will also ask the insurance. They also took pictures too.

Vincent N. Zubowicz, MD · Answer

It's impossible to say whether your carrier will cover breast reduction. The first step is to call your broker directly and see if breast reduction is covered at all. After that you'll have to consult with a plastic surgeon.

Scott C. Sattler, MD, FACS · Answer

In our clinic - we take a full history, physical exam and photos and then along a detailed 'pre-authorization' letter to your insurance company requesting 'permission' to do the surgery for a patient. If all criteria are met, from the insurance company's point of view, then we proceed with scheduling the surgery. Seek out a board certified plastic surgeon in your area to learn more.

Tom J. Pousti, MD · Answer

Based on your description you may be a good candidate for breast reduction surgery; for  physical and emotional reasons.The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.Good luck!

John J. Edney, MD · Answer

First you need to contact your insurance agent and find out whether or not breast reduction is a covered benefit.  Next you need to be evaluated by a board certified plastic surgeon experienced in breast surgery.  It sounds as though you have completed those 2 steps.  After your surgeon submits the information to your insurance company they will make a determination as to whether or not you will be covered.

Adam David Lowenstein, MD, FACS · Answer

I'm sorry to hear about your discomfort but it seems that you are doing all of the right things.  Nobody here will be able to tell you whether your insurance company will help, but your surgeon's letter will get a response and that is where your answers will be found.Best of luck, Dr. Lowenstein

Kevin Tehrani, MD, FACS · Answer

Based on your description, you're on the right track. You seem to be a good candidate for breast reduction procedure. You would need to be examined by board-certified plastic surgeon and medical necessity letter sent in conjunction with your pictures to the insurance company to obtain precertification for your procedure.

Steven Wallach, MD · Answer

It is getting tougher and tougher to get coverage or anything these days. Best to call your insurance company to find out their criteria for approval.

Robert L. Kraft, MD, FACS · Answer

A letter from the primary physician and photos hasn't gotten cases approved by BlueCross in many years.  It's a great way to get a case denied and convince the patient to pay for the operation.  The criteria are much more detailed now and it takes skill, persistence and patience to get through the system.  If you wish, call the K Team and my staff will be glad to schedule a consultation at which time we can explain how the procedure works.

Robert S. Feins, MD, FACS (retired) · Answer

It sounds like you are doing all the right things and your Plastic Surgeon has it under control.  Insurance companies have criteria for breast reduction approval and by submitting your case info, they can tell if they will cover the surgery.The time it takes for a decision varie3s with insurance companies, but a call to the company can't hurt

Will Blue Cross Blue Shield Cover my breast reduction surgery?

Answers (9)

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